Nurses are to care for every patient in their charge, regardless of gender, race, ethnicity, sexual orientation, socioeconomic status, religion, and so on. Nurses give compassionate and competent care every minute of every day to patients they would not be friends with outside of the patient-caregiver context. Indeed, nurses care for people they may strongly disagree with in politics, religion, or just overall beliefs. But nurses do it because that is their job. It is, in fact, what they signed up for.
Marginalized communities have always had barriers to healthcare, and that is true for the LGBTQIA+ community. In particular, the transgender community faces unique struggles in accessing healthcare. The issues are distinct and go right to the core of who they are—their very identity. They deserve the same compassion and competence as every other person.
The Williams Institute of UCLA School of Law published a study in June 2022 that indicates the number of youth who identify as transgender has risen sharply in the last five years. With an estimated 1.6 million transgender people over the age of 13 in the US, healthcare providers need to understand what issues they face and how to care for this marginalized population.
The Issues
Transgender people need the same basic and preventative healthcare as cisgender people. However, studies reveal that transgender people are less likely to seek care out of fear of discrimination. These fears are not unfounded. The LGBTQIA+ community has faced discrimination from everyone, from doctors and nurses to secretaries and insurance companies. Is it any wonder care is avoided or delayed?
Besides basic care, transgender people face many of the same issues as other minorities due to minority stress. These issues include:
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Mental health problems such as depression and anxiety, often due to internalized stigma
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Self-harm and suicidal ideation
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Physical and sexual violence
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Substance misuse
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Sexually transmitted infections
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Inadequate and/or misinformed care from healthcare providers
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Increase tobacco use
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Obesity
Transgender people who wish to transition face another level of healthcare barriers and issues. The aim of this article is not to address these issues specifically but rather to bring to light the disparities for this population. However, it is beneficial to understand just how many considerations, health and otherwise, a person who wishes to transition may face. These include:
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Legislation, including anti-trans legislation and variations from state to state
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Coming out to family, friends, schoolmates, co-workers, boss, etc.
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Parental consent
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Possible job loss
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Changing names and gender in legal documentation
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Pronoun use
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Presenting publicly, which may include changing clothing style and hairstyle or changing body contours to match gender identity (tucking, packing, binding)
The medical side of transitioning includes things like:
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Hormone therapy; which can increase the risk of blood clots, strokes, heart disease, liver damage, and certain cancers
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Top and/or bottom surgery
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Speech therapy
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Hair removal
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Tracheal shave
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Lack of insurance coverage
Discrimination in Healthcare
Across the country, the healthcare needs of transgender people are misunderstood. Many consider changes "cosmetic.” Gender dysphoria, the distress felt when assigned gender at birth does not match gender identity, is not something that is the result of a choice. It is widely recognized by the medical community, including the American Medical Association, American Psychological Association, and the American Academy of Pediatrics, that gender-affirming treatments are critical, not cosmetic.
A study published in the Journal of the American Medical Association shows that administering gender-affirming hormones significantly mitigates mental health issues such as depression and suicidal ideation. It saves lives. And yet many states are passing anti-trans bills that restrict access to things such as hormone therapy and puberty-blocking by barring insurance companies from covering these treatments ... or even defining them as child abuse.
Nurses Can Provide a Safe Space for Transgender People
By recognizing the mountain of difficulties the transgender community faces, nurses are in a position to lend a safe place for them. Thankfully, more research has been done, and therefore resources are available to help guide care. The evidence is starting to surface. One does not need to become an expert in this, but it is worth seeking out these resources to better understand the issues transgender people face and how care can be provided for them in a sensitive, gender-affirming way.
Here are just a few resources and tools to help bone up on definitions, vocabulary, and knowledge so that care is administered in a sensitive way:
Like many things involving inequalities and basic human rights, the issues of healthcare for the transgender population are fraught with politics, personal beliefs, social norms, and cultural traditions. Solutions come over time, piece by piece, and often with setbacks. Complicated problems require a multifaceted approach and collaboration from a variety of stakeholders. But in the end, the transgender community, along with the entire LGBTQIA+ population, deserve to lead happy, healthy lives, feel safe in their communities, and be confident in their healthcare team to do what is best for them.
Definitions
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Gender Identity - an internal identification of one's gender, not always visible to others
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Gender Expression - includes mannerisms, styles, interests, and pronouns that reflect gender. This expression is steeped in cultural norms and heavily influenced by social constructs.
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Nonbinary - an umbrella term that includes experiencing gender identity outside of a male-female binary
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Genderqueer - falls outside the categories of man or woman
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Cisgender - identifying with gender assigned at birth
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Transgender - identifying with a gender other than that assigned at birth
References/Resources
Social Acceptance of LGBT People Ranked By State.pdf
Poverty Rates by Sexual Orientation and Gender Identity.pdf
Meeting the Health Care Needs of Transgender People
Gay & Lesbian Medical Association: Guidelines For care of Gay, Lesbian, Bisexual, and Transgender Patients
Gender Dysphobia
Terminology surrounding Gender Identity and Expression
Study estimates trans youth population has doubled in 5 years
Supporting Trans Youth
PROHIBITING GENDER-AFFIRMING MEDICAL CARE for Youth
Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care
Health concerns for transgender people
What do I need to know about trans health care?
Protect Trans Health: What Do We Want?
LGBTQ Health
National Center for Transgender Equality: Issues/Health & HIV
What do I need to know about transitioning?
Transition Roadmap
The Williams Institute: Infographics
